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sm

we have a 5 mouth old puppy with severe condition of syringomyelia.
we have been offered an operation, can anyone tell us what the aftercare
involved. Has anyone had a puppy as young as this, that has have this operation, that has been a success. We live in the uk and the specialist has not perfored this operation before on such a young puppy. please if anyone has any information can they reple because we do not have long to decide.

I am sorry to hear you have this situation with such a young pup -- it is so hard to have to make these decisions to begin with and it is harder when they have to be made so urgently.

I don't know of anyone (or anyone on this forum) on this forum who has had such a young dog operated on before, but others may know of a similar situation. As you clearly are aware, for a severe case, especially for a dog so young, the surgery is probably the only long-term treatment possibility you have.

Has your neurologist spoken to others who have done a surgery on a dog this age?

In your situation I think I would want to know two things:

1) could the neurologist see if there are other examples of dogs having this surgery at this age, and what the outcomes were

2) is the neurologist experienced at the decompression surgery generally on cavaliers, and does s/he know this condition fairly well

If the latter is yes, and they know this condition well, and believe the surgery would have a good chance of a positive outcome, then I would go with their judgement, if I also felt that surgery was the right option. I'd worry less about the age of the dog and more about whether they feel there's a good chance of a positive outcome. The surgery has been performed successfully on dogs that would be smaller than a 5 month old cavalier -- mini yorkies for example and chihuahuas -- so I would be less concerned about the age of your pup and thinking more about the general prognosis.

There are several people here who have gone thru the aftercare and can tell you more about that. In many cases the dogs were pretty much up and about right away and mostly needed to be kept from doing too much. With a puppy your challenge will be to keep the pup as calm as possible and the activity level low. Many people crate their dogs initially, or pen them in an ex-pen (exercise pen, which is a small, portable set of panels that form an indoor pen). A lot seems to depend on how severe the dog is at the time of surgery.

thank you

to karlin thank you for replying back, my other concern is that i have two others dogs which may knock her accidentally, my other concern is that will the scar tissue grow over after the operation as she still is growing. The youngest dog he has operated on is 9 months old. Will the puppy get so depressed staying in the cage for so long.

Everyone's experience is different I think -- some dogs seem to have a longer recovery, some are back on their feet fairly quickly. An ex-pen will allow you to keep the pup separated from the other two dogs. You'd need to keep the pup on its own for a while. Many people feel that overdoing exercise and activity post-op probably can put extra strain on their recovering dog -- many felt they let their dog do too much too soon. Basically controlled recovery is what you are looking for.

Scar tissue always is a risk. SM isn't very well understood nor the situations which might dispose a dog to developing scar tissue but I have not heard that a younger dog for example would be more at risk of this. Human children also have the decompression surgery and I don't think recovery is different in children: it's just that some individuals, whether people or animals, seem more inclined to develop scar tissue that can cause a recurrence of problems. The majority of dogs either have no further progression or have additional recovery after the surgery, but 1/4th to a third do have a recurrence (some soon, but some many years later; some severe, some mild).

This is a very difficult condition to be facing, especially when it is severe, and there are no definite answers. I know all of us with affected dogs face these dilemmas about what to do and when to do it; but with a severely affected dog it is all so much more difficult -- there's so little time to make decisions and none are easy.

I'm so sorry that your pup has this. My Rory has SM and began showing mild signs at about 4 months. We pursued surgery at 20 months and he is doing well post=op, but he was not showing very severe signs when we decided to do the surgery. He is not 100% better, and may be worse. Hard to say because we also started him on medication post-op that has really really helped. If he misses a dose, then he gets very irritated and scratchy. Right now he is convinced something is biting his back feet and desperately trying to get away from wherever the evil feet biting monsters are.... Even though he just got his medicine 4 hours ago...

Basically - the surgery is not 100%. You need to know this. It is not a cure. It can halt progression, but not always. I am not sure it halted progression for Rory. But even so, I know it was the best choice for him to possibly lead a normal life. He is also on Gabapentin and Lasix (frusemide) and this definitely helps.

If your dog is very severely affected, then your options are probably to pursue surgery and keep your fingers crossed, or try to keep her comfortable for as long as possible... If surgery is an option for your family (it is a big financial commitment) then I would say go for it. What have you got to lose? For me - I knew that even if the surgery didn't work, I had to try it. I had to give him that chance. I do not regret it for a moment.

I would, however, see about travelling to a more experienced vet. Are you anywhere near London?? Dr. Clare Rusbridge is the premier neurologist/researcher on this disease in the UK. Myself, I flew about 4 hours away to have the surgery performed by a neurologist who I felt very comfortable with and who had performed the most surgeries that I was aware of. Also - Dr. Rusbridge may be trying the new mesh placement to prevent scar tissue?? I think?

Please feel free to PM me if you have more questions about any of this.
-Kendall

Dogs are not our whole life, but they make our lives whole.
--Roger Caras

She is still not sure about the mesh -- someone posted recently on this elsewhere; she is waiting to see what the results are coming back. As so far they only have results from under 12 months I think she wants more conclusive evidence that it helps.

I do know from talking to some owners and many neurologists that a lot of dogs go on to quite normal lives but there are a good third that will continue to progress after time. My sense is that most dogs with the surgery do get many more years of a decent quality of life as opposed to either having no future without it (as is generally the case with severe cases) or a much more restruicted quality of life. Not all feel they want to put a dog through such a surgery though, for a variety of reasons.

Many neurologists are also changing their former recommendation that surgery only be done when a certain level of severe symptoms begin to show. Evidence from human decompression surgery and the dog surgeries are that the earlier the surgery is done, the better chance for the dog's recovery (setting aside that scar tissue does form). I think now many would argue that outward sympoms such as pain would not be the primary consideration any longer on judging a severe case, but the actual results of an MRI. Some dogs seem much better at either accommodating pain or not developing severe symptoms even when they have quite severe SM on MRI.

It may well be that a dog that had severe SM on MRI but wasn;t showing severe symptoms at the time of surgery, might go on over time to have those more severe symptoms show up, as some of the physical damage has already been done. In the same way, an injury to a bone joint for example may not show any noticeable pain in someone who is young, but with the passage of time, may contribute to severe arthritis.

Even after the surgery, a dog with a lot of syrinxes already may not have those syrinxes ever disappear -- so presumably they continue to obstruct CSF flow and more damage can occur over time? That would be my guess on what happens with some of the cases where there's severe SM but not initially, severe symptoms. Maybe the surgery and the removal of the obstruction will over time cause a subsidence of symptoms that may intitially increase. But all the neurologists have different opinions on whether symptoms increase or decrease, and by how much, and what prolonged symptoms mean.

I also wish there were more direct comparisions of the results of shunts v decompression. Mr Skerritt only does shunts and I know from actually duiscussing this with people whose dogs have had them, some dogs have gone on to a totally normal life as well. Dr Dewey feels shunts are far more invasive than decompression; Mr Skerritt doesn't. No one has compiled a comparison of the techniques. But then, no one except Mr Skerritt was using frusemide for years and years; now it has suddenly become something many neurologists are using and people clearly do see their dogs respond to it.

This would be a wonderful research project for someone -- to start to work with say Dr Rusbridge and Mr Skerritt compiling case studies and contacting owners of dogs that have had the surgery and build a profile of surgical success, and how many years out some of these dogs are from surgery. I know of one dog 7 years post shunt that is on no medication, another about that many years post decompression also I believe on no medication. I know Dr Rusbridge has dogs 5 or 6 years out from surgery that are doing fine, some on no medication at all. So it is very hard to predict success and why or why not.